Some Children May Need Cholesterol Medication

< July 9, 2008 > -- A leading group of pediatricians has released new guidelines that advise kids as young as 8 years old should be given cholesterol-lowering medications in hopes of preventing heart problems later in life.

The new recommendations come as a result of the reality of rising rates of childhood obesity in the US.

The American Academy of Pediatrics (AAP) also recommends that children as young as 2 years old start having their cholesterol levels screened if they have a family history of heart disease or high cholesterol. Screening should start no later than 10, the AAP says.

The recommendations were published in the journal Pediatrics.

Screening More Aggressively Called For

Dr. Steven P. Shelov, chairman of pediatrics at Maimonides Medical Center and head of Maimonides Infants & Children's Hospital in New York City, says he agrees with the new guidelines.

"More aggressive screening is a good idea, and the use of [cholesterol-lowering] statins at relatively low doses will keep cholesterol at safer ranges," he says.

Statins are a group of antihyperlipidemic (cholesterol-lowering) medications, and include simvastatin (Zocor®), atorvastatin (Lipitor®), and pravastatin (Pravachol®), among others.

The AAP also recommends that children whose family history of cholesterol is not known, or who have risk factors for heart disease - including obesity, high blood pressure, or diabetes - have their cholesterol tested.

Some 30 percent to 60 percent of US kids with high cholesterol are falling through the cracks, being neither diagnosed nor treated.

Start With Fasting Blood Test

According to the recommendation, the best method for checking cholesterol is a fasting blood test. Children whose cholesterol is normal should have the test repeated every three to five years.

For those children older than 8 who have high levels of LDL (bad) cholesterol, doctors should consider giving them statins.

For younger children with high cholesterol, lifestyle changes such as losing weight and increasing physical activity, as well as nutritional counseling, should be considered.

Also, for children age one year and older who may be overweight or obese, the AAP recommends giving them low-fat dairy products such as 2 percent milk and other low-fat dairy foods.

Impact of Medications Considered

Dr. Shelov, who was not involved in drafting the recommendations, says he is not overly concerned about giving statins to children. Side effects are rare, and the benefits of the drugs make them worth the risk, he says.

"The levels of obesity we are seeing and the unsafe level of cholesterol now in our teenagers - even down as young as our fourth- and fifth-graders - this recommendation appears to be well thought out," he says.

Dr. Shelov admits that very little is known about the risks and benefits of using cholesterol-lowering drugs like statins in a large pediatric population.

Potentially, millions of children could be placed on cholesterol-lowering drugs, he says. "At the same time, there needs to be a systematic look at the effects of these medications on children, because they do have side effects," he adds.

"If we are going to go ahead and do this, we're going to need guidelines on exactly who would warrant the therapy and careful measurement of any side effects," Dr. Shelov says.

It is possible that many children who start taking statins may not require them for life. Changes in diet and exercise could have some children off the drugs in a relatively short time, Dr. Shelov says.

Always consult your child's physician for more information.

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Facts About Cholesterol

Cholesterol is a waxy substance that can be found in all parts of your child's body. It aids in the production of cell membranes, some hormones, and vitamin D.

The cholesterol in blood comes from two sources: the food your child eats and his/her liver. However, your child's liver makes all of the cholesterol the body needs.

Cholesterol and other fats are transported through the bloodstream in the form of round particles called lipoproteins. The two most commonly known lipoproteins are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

LDL cholesterol is commonly called "bad " cholesterol. It can contribute to the formation of plaque buildup in the arteries, known as atherosclerosis.

LDL levels should be low. To help lower LDL levels, help your child to:

HDL cholesterol is known as "good" cholesterol, and is a type of fat in the blood that helps to remove cholesterol from the blood, preventing the fatty build up and formation of plaque.

HDL should be as high as possible. It is often possible to raise HDL by:

exercising for at least 20 minutes three times a week.

avoiding saturated fat intake.

decreasing body weight.

For some children, medication may be needed. Because raising HDL can be complicated, you should work with your child's physician on developing a therapeutic plan.

Physicians in the past felt that children were at little risk for developing high cholesterol levels and other risk factors for heart diseases affecting the coronary arteries and blood vessels until later in life.

However, many physicians now realize that children are increasingly at risk for having high blood cholesterol levels as a result of one or more factors, such as sedentary lifestyles, high-fat junk food and fast food diets, obesity, and family history of high cholesterol levels.

Always consult your child's physician for more information.

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